DEVELOPING AND ENHANCING THE WORKFORCE FOR CHEMICAL DEPENDENCY TREATMENT

Robin Roberts David Jefferson

WORK FORCE DEVELOPMENT

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What Is WFD?

Webster does defines 1: the workers engaged in a specific activity or

enterprise <the factory's workforce> 2: the number of workers potentially assignable for

any purpose <the nation's workforce> de·vel·op·ment

Lawrence M. Anthony, EdD, LICDC University of Cincinnati

1: An integrated process requiring participation and cooperation of several employment related institutions whose goal is to help develop and maintain a viable workforce.

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What Is The Number One Public Health Issue?

Addiction is a serious disease and the number one public health issue in the United States today. According to the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), there were approximately 10.3 million individuals in 1999 with drug or alcohol dependence and 1.6 million admissions to drug and alcohol abuse treatment centers.

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What Are The Main Workforce Issues?

Recruitment Retention Education and Training

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Recruitment

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RecruitmentIs There A Shortage Of CDP’s ?

40% of agency directors report that their agency is understaffed with the average staff vacancy of 1.10 FTE per agency with the

Overall shortage average of all treatment agencies at.50 FTE per agency 54% of agency directors reported staff shortages are budget related the

remaining 46% stated they would still be understaffed if all budgeted positions were filled

49% of directors indicated that they expect to hire staff, reporting an average of 1.92 FTE in planned hires

The number of planned hires per agency ranged from 1 to 10 FTE, CDP’s accounting for 79% of all planned hires

Agencies employ on average 10- 11 treatment staff, and estimates indicate that on average, agencies have 3- 5 CDPT’s for every 10 clinicians.

Nationally the U.S. Department of Labor has predicted that the need for substance abuse professionals will increase by 33% over the next decade

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What Is The Number Of CDP’s Needed In WA State?

Currently there are 2, 560 active Chemical Dependency Professionals and 746 expired credentials in the state of Washington.

CDP’s certified each year by DOH has fluctuated drastically from a high of 580 in 01 to a low of 106 in 02.

DOH on average is processing an average of 12 applications each month over the last 4 years. An average of 149 new CDP’s certified each year (115 certified for 06 so far.

Based on survey data from the agency directors, 280 additional CDP’s are needed. Note: This does not include the 10% (256) who indicated that they plan on leaving the field soon.

Estimated current CDP deficit is 131, if there are 149 new CDP’s certified this year. The potential of an additional loss of 10% (256) in a worst case scenario could result in 387 CDP’s positions not filled.

The effect of Treatment Expansion further increases the need for CDP’s given an expected 5% to 10% increase in patients caseload each year.

Nationally the U.S. Department of Labor has predicted that the need for substance abuse professionals will increase by 33% over the next decade.

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Aging Out Of The Workforce

70% of directors and 37% of clinicians are 50 years old or older

15% of clinicians are in their 60’s 27% of directors are 60 years old or older and

comparisons between 02-05 data indicate an increase in directors who are 60 years old or older

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Agency Level Turnover 2002 survey the turnover rate was 22% and 2005 turnover rate

is 23% 61% of clinicians leave for another agency, 49% of clinicians leave for another allied field 10% of all clinicians report that they are strongly considering

leaving the field from the 05 data Two factors appear to be statistically significant predictors of

turnover: (1) years experience of the director (more experience, less turnover), and (2) clinical supervision (more frequent clinical supervision, more turnover)

Most turnover in the state is agency to agency turnover Nationally the turnover rate is approximately 11%

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What Are The Reasons For Turnover

Based on director and clinician reports of why clinicians have quit, better salary, better work opportunities (within the field), and burnout all appear to be significant factors

Results indicate that for directors, level of job satisfaction is the lone significant predictor for membership in the changer category

Recovery status and second career status are both significant predictors for director’s membership in the leaver category

Directors not in recovery and who report that substance abuse treatment is a second career are more likely to be considering (with high or definite probability) leaving the field

A statistically significant larger proportion of clinicians at agencies with 2 or fewer staff report their likelihood of changing agencies is “not at all” clinicians may find working in smaller agencies less stressful

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Retention

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Retention Strategies

Increase salaries and provide salary raises for increased education and training programs completed

Reducing paperwork Creating incentive and opportunities for

personal growth and advancement Flexible schedules for some positions Hiring the best person in the first place (use of

structured interviews, team interviews, writing exercises, etc)

Major Challenges and Cross-cutting Issues of the

CD Treatment Workforce

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Competency or?

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Competency

“...a measurable human capability that is required for effective performance…”

“…comprised of knowledge, a single skill or ability, a personal characteristic, or a cluster of two or more of these…”

“…are the building blocks of work performance…”

-- Marrelli et al

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Competency

Education

Standards

Training

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Competency Variation and a lack of standardization in educational programs

(curricula, degree programs) difficulty in transferring credits NAADAC certification for all Community College CD programs Special populations needs. Is there a need for a adolescent

treatment specialist for example. This specialization is the subject of study with the DASA Adolescence Substance Abuse Treatment Coordination Grant.

Other Special Populations (Older Adults, ethnic minorities).

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Competency

Training – Use of evidence-based practices– Outcome measurement– New medications– Addiction treatment (primary health

care, allied health professions)

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Cross-Cutting Issues

Stigma

Noncompetitive compensation

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Stigma Negative consequences of stigma

associated with substance abuse profession

– Difficulty in recruitment and retention Addiction professionals considered lower

status than other professionals Reluctance to enter the field

– Contributes to noncompetitive salaries– Misconceptions about treatment, and the

qualifications of a clinician

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Compensation Low Salaries

– In 2002, average salaries in low $30,000s – Majority of counselors (61%) earned between

$15,000 and $34,000 – Majority of agency directors (68%) had salaries

ranging from $40,000 - $75,000– In 2005 67% of clinicians made less than $35,000 a

yr. (88% less than $45,000)– In 2005 69% of clinicians report being the primary

wage earner for their family Factors associated with higher salaries: graduate

degrees, certification, and years in the field

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Compensation

Inadequate health care coverage among professional staff

– 30% had no medical coverage– 40% no dental coverage– 55% not covered for substance use or

mental health services (Counselor, 2004)

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WFD Position Updates DASA Director’s

Professionalize the field RC to CDPT classification Increase collaboration with key partners, DOH, NCCDE,

others Rate study possibly leading to rate increases. The

Residential Rate Study was completed in and recommended An Outpatient Rate Study will be completed in October

Three Million Capital improvement grants to the field Tuition Waiver program to meet CDP educational needs Updating of the DASA and Job Line Website for WFD Completion of a CDP recruitment brochure WFD Specialist within DASA

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NCCDE Update

• NCCDE is interested in applying as a group for NAADAC certification which could be a step toward streamlining the process of being certified

• NAADAC-certified CD programs that are members of NCCDE might offer certificates of achievement for CD coursework that would be pre-approved as meeting DOH requirements for CDP certification, potentially replacing or streamlining the DOH CDP application process

• NAADAC is certifying more and more organizations and most likely would certify NCCDE

• The process if fairly quick and inexpensive, as outlined on the NAADAC website

• Would NAADAC certification benefit NCCDE? This will be explored by NCCDE with DOH and the potential benefits of NAADAC certification, will be presented at the next NCCDE meeting on October 13 in Ellensburg

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CDP Advisory Board Update

The CDP advisory committee is mandated by law to further the purposes of the law as administered by the DOH related to the certification of CDP’s”

DOH state wide CDP forums in February 2006 DOH has allowed applicants who receive letters regarding investigation

to take back the application with out penalty DOH is looking at applications to determine investigation based on how

recent the date of the crime and recommending investigations based on the nature of the alcohol/drug related crime

Education requirements; made some progress evaluating the similarities and differences between programs

Provisional licensing for graduate level professionals was not approved. DOH with under the advisement of the CDP Advisory group has

granted reciprocity with Idaho ICRC and Oregon CADC II and is looking into  reciprocity with other states.

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NAADAC Update Facilitate the conversation regarding the current state of

DOH counselor registration and the impact it has on WFD Develop a strategy with the CDP organizations and DASA

to move the counselor registration back to DASA Develop a plan to recognize the current Certification

Boards in Washington State and facilitate a productive working relationship with DASA

Begin the conversation of a WFD Strategy with the CDP organizations and DASA

Use the skills of NAADAC's Government Relations person to help us strategize on the plans we envision

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NADACC Continued

Counselor registration back to DASA with less red tape, more equitable requirements, systems to accept counselors from other states in a seamless manner, etc.

Chemical Dependency Counselor Organizations working more effective and productively with DASA

State wide approach to an Strategic Plan for WFD - invested in by the organizations and DASA

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Tribal Update Need regional testing sites as opposed to one site in Seattle Acceptance of certification from the Indian Substance Abuse Counselor Certification Board. Need counselors that are culturally competent More flexibility from DOH

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Treatment Staff

Chemical Dependency Professional (CDP) means a person certified by the Washington State Department of Health (DOH) Health Professions Quality Assurance Office

Chemical Dependency Professional Trainees (CDPT’s) means a person assigned a trainee position by an administrator of a state of Washington certified chemical dependency service agency

CDPT’s are required to be registered as a counselor or have a current license issued by the DOH

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What Are The Seven Basic Steps To Becoming A CDP?

There are seven basic steps to becoming a Chemical Dependency Counselor, listed below. Note that these are not detailed instructions, only a guideline. for more detailed instructions, on the web go to https://fortress.wa.gov/doh/hpqa1/hps7/Chemical_Dependency/default.htm for a Chemical Dependency Professional License Application Packet or contact the Department of Health (D.O.H.) at (360) 236–4700

1. Register with the D.O.H. as a counselor. Call the D.O.H. Application Packet Line at (360) 236-4700 and press option 1 to request an application to register to counsel. Leave your name and address and a packet will be automatically sent to you

2. Submit the application with a fee of $40 to D.O.H.3. Complete the Chemical Dependency college courses and an AA degree..4. Complete the supervised internship hours5. Submit an application to D.O.H. for "Chemical Dependency Professional" status with

a $100 application fee and a $125 initial certification fee, both non-refundable.6. Take and pass the written examination.7. Receive your CDP credentials!

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How Do I Become A CDPT? There are five basic steps to becoming a CDPT listed

below. Note that these are not detailed instructions, only a guideline. For more detailed instructions obtain a Registered Counselor Application Packet or contact the Department of Health (D.O.H.). For quick answers to frequently asked questions, check out the FAQ’s on this website1. Submit a completed application for Registered Counselor

along with your personal explanation and documentation of any “yes” answers to the personal data questions;

2. Complete four (4) hours of AIDS/HIV training;3. Submit the $40.00 application fee to the DOH;4. Verify other credentials held in this or in other states even if

credential is not currently active;5. Receive your CDPT credentials!

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Governor’s Directive to Department of Health to review existing statutes and regulations for registered counselors by

September 1, 2006.

Submitted by Chemical Dependency Professionals SubgroupChemical Dependency Professional TraineesJuly 2006 to the Governor’s office for review the following:

Revise RCW 18.205 - Chemical Dependency Professionals, to create a new RC certificate aligned with CDP certification. The new credential might be RC-CDP Trainee or CDP Trainee.

An RC-CDP Trainee must attest annually, after receiving a certificate, to actively pursue the educational requirements per WAC 246-811-030 to become a CDP.

Should CDP Trainees demonstrate certain core competencies before providing specific counseling services to patients? Yes but that has not been defined yet.

Should they take an exam? While a state exam for RC-CDP Trainee is not required, the RC-CDP Trainee is required to take and pass a number of exams in core competency counseling areas while completing the education requirements to become a CDP.

How should they be supervised? CDP Trainees are supervised under the authority of DOH WAC 246-811 and DASA WAC 388-805. WAC 246-811 describes supervisor qualifications while WAC 388-805 describes elements of supervision.

Should there be an interim permit for those intending to become licensed or certified? Yes The new RC–CDP Trainee certificate should be time limited, e.g., five – six years, at which time the RC-CDP Trainee will be expected to complete his/her education, training, and experience to become a CDP.

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Key Themes

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Participant Question

What do you think are the key themes in workforce development?

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Key Themes Compensation, Competitive Salaries and Benefits Aging out of the workforce Integrated strategic planning by key entities Improve clinical supervision Training for clinical and recovery support supervisors Investigate loan forgiveness and repayment programs Develop career paths and establish national core competencies Develop leadership and management initiatives Provide support related to relapse in the workforce Provide education on addiction treatment within other disciplines Standardize Education CDP programs in the state Recommend that all CDP programs in the state become

NADDAC certified.

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The Future

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Participant Question

What skills and competencies will you need to prepare yourself for the CDP workforce of the future?

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Will You Be Ready For A Productive Future In The Workforce

Preparing for integrated treatment of Co-Occurring Disorders

Preparing for working with other special populations Expertise in Evidenced Based Program and

Implementation Connecting to the systems that further WFD Have the leadership skills needed in a changing work

world. Have the clinical supervision skills to adequately

supervise those in training and those with advanced skills.